UN reports progress against HIV in poor countries

WASHINGTON — A push to get more AIDS treatment to the world's poorest, hardest-hit countries is paying off as deaths inch down — and new infections are dropping a bit, too, the United Nations reported Wednesday.

"I personally believe it is a new era, new era for treatment, new era for prevention," said Michel Sidibe, executive director of UNAIDS, the Joint United Nations Program on HIV and AIDS.

Some 34.2 million people worldwide were living with the AIDS virus at the end last year, a slight rise from the previous year as better treatment helps patients live longer.

Most of them live in low- and middle-income countries, where a record 8 million people received life-saving drugs last year, the report found. That's up from 6.6 million in 2010, and puts the world on track to meet a U.N. goal of having 15 million people in those hard-hit regions on treatment by 2015.

The report comes days before the world's largest AIDS conference opens in the nation's capital with the goal of finally "turning the tide" on the epidemic and stemming the spread of the HIV virus.

Treatment is one of the keys to doing that because it doesn't just save the lives of people living with HIV. Recent research shows early treatment, so patients stay healthy, also makes them far less likely to infect others.

"We need to get that number up as rapidly as possible," said Chris Collins of amFAR, the Foundation for AIDS Research, who called the 2011 increase in treatment higher than expected. "If we can get to scale with AIDS treatment, we're not only saving lives but we're preventing infection and beginning to end this epidemic."

The UNAIDS report found there were 1.7 million deaths from the virus last year, down from 1.8 million.

Better, the new data show 2.5 million people became infected with HIV last year — 100,000 fewer than in 2010. New infections have fallen by nearly 20 percent worldwide in the past decade.

Perhaps most encouraging is the steady drop in new infections in children, mostly due to treating HIV-infected pregnant women so they don't pass the virus to their babies. About 330,000 children became infected in 2011, almost half the number that were being infected at the epidemic's peak in 2003.

The world spent $16.8 billion battling AIDS in the hard-hit countries last year. Sidibe said an important reason for the progress is that affected countries are paying more of their share — for the first time, totaling a bit more than wealthier donor nations paid — as they see the fruits of the investment. South Africa alone spent nearly $2 billion last year.

But, "we are still short $7 billion" of the yearly total it will take to get to the 2015 treatment goal, Sidibe warned, urging increased spending despite the global financial crisis.

Other challenges:

—Young people ages 15 to 24 account for 40 percent of new infections — twice as many young women as men, the report found.

—Nearly 60 percent of the 1.5 million pregnant women living with HIV in poor countries received effective anti-AIDS medications. Another international goal is to nearly eliminate infections at birth.

—New infections continue to rise in some parts of the world, including eastern Europe and central Asia. Even in the United States, they're holding steady.

—And dozens of countries have laws that fuel HIV spread in such ways as criminalizing same-sex sexual activity, so that populations at high-risk are too scared to be tested or treated.

Some countries are scaling up treatment at a dramatic pace — including Botswana and Namibia that have the majority of their residents who qualify for AIDS drugs now on them, said World Health Organization AIDS director Dr. Gottfried Hirnschall. A key is to shift away from providing the drugs only through expensive doctors and clinics, and instead through community programs that also offer peer counseling and other services that encourage people to keep taking the medicine.

A WHO study shows that resistance to the drugs is growing slowly in poor countries despite the rapid increase in medication use.

Now the WHO is urging poor countries to use the medicines in ways that maximize their chances of preventing new infections. While the U.S. advises people with HIV to start treatment as early as possible, that's not financially possible in poor countries, where the WHO advises starting once a person's immune system weakens to a certain degree.

But Hirnschall cited important exceptions. Up to half of HIV-infected people in ongoing relationships have partners who still are free of the virus, and those people need treatment regardless of their immune strength, he said. Rwanda and Zambia have begun implementing that policy, and more than a dozen other countries are considering it.